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What is refeeding?
Refeeding syndrome can develop when someone who is malnourished begins to eat again. The syndrome occurs because of the reintroduction of glucose, or sugar. As the body digests and metabolizes food again, this can cause sudden shifts in the balance of electrolytes and fluids. These shifts can cause severe complications, and the syndrome can be fatal.
It may take as little as five consecutive days of malnutrition for a person to be at risk of refeeding syndrome. The disease can be treated and can be stopped if doctors notice warning signs early.
Symptoms of the condition typically become evident within a few days of malnourishment diagnosis.
What are the causes of refeeding syndrome?

When a person doesn’t eat enough, he or she will easily go into starvation mode and become malnourished.
The ability to store food is seriously pimpaired after a prolonged period of famine.
A malnourished body produces less insulin, and this reduces carbohydrate development.
When the body has insufficient carbohydrates, it uses nutrition from the fat stores and stored proteins.
When the body tends to depend on fat and protein stores over time this will alter the electrolyte balance. Vitamin and electrolyte levels are rising as the body continues to adjust to the mode of starvation. The levels of potassium, phosphorus, magnesium, calcium and thiamine are usually impacted.
Once food is reintroduced the body no longer has to rely on fat and protein stores to produce energy.
Refeeding therefore requires an sudden metabolism change. It occurs with an rise in glucose, and the body responds with more insulin secretion. It will result in a lack of electrolytes, including phosphorous.
Refeeding syndrome may cause hypophosphatemia, which is a phosphorus deficiency disease. This may also cause other essential electrolytes to have low levels.
The adverse effects of refeeding syndrome are common, and may include:
- heart
- lungs
- kidneys
- blood
- muscles
- digestion
- nervous system
If doctors are unable to treat the syndrome, it can be fatal.
Who is at risk?
Refeeding syndrome affects people who do not receive enough nutrition.
This may be because of:
- starvation
- malnourishment
- extreme diets
- fasting
- famine
The following medical conditions can also increase the risk of developing refeeding syndrome:
- anorexia
- cancer
- alcoholism
- problems swallowing, or dysphagia
- inflammatory bowel disease
- celiac disease
- depression
- painful conditions affecting the mouth
- uncontrolled diabetes
Undergoing particular surgeries, especially weight loss surgeries, can also increase a person’s risk.
Symptoms
Electrolytes play a very important role in the body. The most common problem when the balance is distorted is hypophosphatemia which is a lack of phosphorus.
Symptoms of hypophosphatemia include:
- confusion or hesitation
- seizures
- muscle breakdown
- neuromuscular problems
- acute heart failure
Refeeding syndrome may also cause magnesium deficiency. Hypomagnesemia is the term for hazardously low magnesium levels.
Signs and symptoms of hypomagnesemia include:
- low calcium levels, or hypocalcemia
- low potassium levels, or hypokalemia
- weakness
- fatigue
- nausea and vomiting
- abnormal heart rhythms
Refeeding syndrome can also cause a dangerously low fall in potassium levels. It might lead to:
- fatigue
- weakness
- excessive urination
- breathing problems, such as respiratory depression
- heart problems, such as cardiac arrest
- ileus, which involves a blockage in the intestines
- paralysis
Other symptoms include:
- hyperglycemia, or high blood sugar
- mental problems, such as confusion
- abnormal serum sodium levels
- fluid retention
- muscle weakness
In some cases a deficiency in potassium can lead to a coma or death.
Doctors can identify people at risk for refeeding syndrome, but it can’t be known if a person will develop it. It’s important to try to keep the condition from developing.
Risk factors

Those who have previously died of starvation have the greatest chance of developing refeeding syndrome.
If a individual has an extremely low index of body mass, the risk is high.
People who have lost weight quickly recently, or who had little to no food before beginning the refeeding cycle are also at substantial risk.
Other people at risk include:
- children or adolescents with severely restricted calorie intakes, when this occurs with vomiting or laxative misuse
- children or adolescents with a history of refeeding syndrome
- frail individuals with multiple medical problems
Regardless of age, a person is at high risk if they have:
- a BMI of less than 16
- lost more than 15 percent of their body weight unintentionally in the past 3–6 months
- consumed minimal food over the past 10 consecutive days or more
- low levels of serum phosphate, potassium, or magnesium
Two or more of the following issues also increases the risk of developing refeeding syndrome:
- a BMI of less than 18.5
- unintentionally losing 10 percent of body weight in the past 3–6 months
- consuming little or no food in the past 5 consecutive days or more
- a history of alcoholism or drug abuse
- receiving some treatments, such as insulin, diuretics, chemotherapy drugs, radiation therapy, and antacids
Anyone suspecting having refeeding syndrome should receive urgent medical attention.
What are the treatment options?
People with refeeding syndrome need to get back to normal electrolyte levels. This can be done by doctors removing electrolytes, normally intravenously.
Vitamin replacement, such as thiamine, can also help to relieve other symptoms. A person will need a continuous replacement of vitamins and electrolytes before the levels stabilize.
The refeeding process can also be delayed by doctors to help a person relax and heal.
In a hospital the person will require continuous observation. Doctors can use procedures to track electrolyte levels and body functions, including urine and blood samples.
Recovery
Times of recovery differ depending on the severity of the disease and malnutrition.
Treatment can last for up to 10 days and follow up can last.
When a person has complications or underlying medical conditions, treatment may lead to longer periods of recovery.
Can it be prevented?
The most effective way to tackle refeeding syndrome is by avoidance.
Health care workers who are conscious of warning signs and risk factors are better able to handle people suffering from malnourishment.
Researchers found in 2013 that 4 percent had refeeding syndrome in a wide group of people being fed intravenously in the UK. The authors noted that about half of the at-risk patients had the risk identified by physicians.
Healthcare professionals may prevent the syndrome of refeeding through:
- quickly identifying those at risk
- adapting refeeding programs
- monitoring patients continuously once treatment has begun
Malnourishment can result when food intake is severely limited. This may occur in people with:
- depression
- dysphagia
- alcoholism and drug use
- anorexia nervosa
- uncontrolled diabetes
Surgery and diseases such as cancer can contribute to increased metabolic demands, which can contribute to malnutrition.
In addition, malnutrition may occur when the body no longer absorbs nutrients as it should. It may be caused by disorders like celiac disease and inflammatory bowel disease.
High risk patients with malnutrition and refeeding syndrome need to be detected and treated. Guidelines note that prior to refeeding, doctors would assess an individual’s alcohol consumption, diet, weight changes, and psychological health.
Takeaway
Refeeding syndrome may occur after a time of starvation or malnutrition, when food is reintroduced too quickly. This can lead to electrolyte imbalances and severe, possibly fatal complications.
The best way to combat the refeeding syndrome is by finding and treating people at risk. People with the syndrome will recover early on when they undergo care. Might help with education and increased knowledge of the disease.
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Rhinophyma: Everything you should know
Rhinophyma is a skin condition that causes the nose to expand. Lumpy, thicker skin and fractured blood vessels are some of the other signs.
Males are far more likely than females to get the condition, which usually occurs between the ages of 50 and 70.
Researchers aren’t sure what causes it, but they do know that acne rosacea, which causes inflammatory pimple breakouts, is a precursor.
When acne rosacea advances to rhinophyma, the skin around the nose swells and the tip of the nose becomes larger. A diagnosis is made based on this distinctive appearance.
In the early stages, medicines are used, but in the latter stages, surgery is required. This is due to the possibility of damaged tissue obstructing the airways. The technique is safe and effective at smoothing or removing rough, thickened patches of skin.
Continue reading to find out more about the causes, symptoms, diagnosis, and treatment of this condition.
Causes of rhinophyma
Rhinophyma is characterized by an increase in the number of sebaceous glands (oil glands) and underlying connective tissues in the face. According to studies from 2021, the actual cause is still unknown, and various causes could be involved. A variety of disorders affecting the immune system, nerves, and blood arteries are included.
Acne rosacea, a long-term skin condition more common in women, is the prelude to rhinophyma. Rhinophyma develops in a subset of acne rosacea people.
Rhinophyma is more common in men, with a male-to-female ratio ranging from 5:1 to 30:1, and it usually develops in people between the ages of 50 and 70. Scientists believe that male hormones raise the danger because of the higher prevalence in men.
Some people believe that drinking alcohol causes the condition, however studies show that this is not the case. However, both alcohol and caffeine enlarge blood vessels briefly, aggravating rhinophyma.
In its early beginnings
According to evidence, rhinophyma begins as “pre-rosacea,” with face flushing being the only symptom.
The condition progresses to vascular rosacea, which is characterized by enlarged blood vessels and redness. Acne rosacea causes later, resulting in inflammatory outbreaks.
Finally, acne rosacea progresses to late-stage rosacea, which includes rhinophyma.
Symptoms
The first symptom of rosacea is frequently excessive face flushing. If it evolves to rhinophyma, a person may experience the following symptoms:
- thickened skin on the nose and elsewhere on the face
- expansion of the tip of the nose
- a bumpy texture on areas of the face
- enlarged pores
- oily skin
The condition may restrict the airways at this moment. In addition, because the fluid from the sebaceous glands thickens and can contain bacteria, persistent infection is common.
The amount of sebaceous glands and connective tissue alterations grow with time, resulting in increasing deformity.
Furthermore, there is a relation to cancer. Basal cell carcinoma affects 3–10% of people with rhinophyma, despite the fact that the condition is initially benign.
Diagnosis
Rhinophyma is often diagnosed with a visual examination due to its distinctive look.
The presence of at least one primary feature and at least one secondary feature is used by doctors to make a diagnosis.
The following are the main characteristics:
- blushing
- persistent redness
- pustules, small pimples containing pus
- papules — small, solid pimples that are usually inflamed but do not produce pus
- broken or dilated blood vessels near the skin’s surface
Secondary features include:
- roughened patches of skin on the face
- swelling
- burning or stinging areas of the skin
- eye symptoms, such as watery eyes or swelling of the eyelids
- marked thickening of skin or excess tissue
- these symptoms elsewhere on the body
Treatment
There are nonsurgical and surgical options available.
Non-surgical options
Certain drugs appear to be beneficial, according to the findings. Topical metronidazole (Metrocream) is one option for reducing skin inflammation by preventing the production of reactive oxygen species.
Isotretinoin, a medicine that shrinks the sebaceous glands and reduces the amount of oil they produce, is another choice. If a person wants surgery, however, they must stop taking this drug.
Surgical intervention
Advanced rhinophyma necessitates surgical removal of the afflicted tissue. A report published in 2020 describes a five-step surgical procedure for rhinophyma that is both safe and effective:
- Dermabrasion: A motorized device resurfaces the skin to facilitate the next steps.
- Dermaplaning: This involves removing affected tissue without directly cutting it. It prepares the skin’s surface for the third step.
- Debulking: The surgeon uses curved scissors to cut away the thickened skin. They also take samples of any areas that may be malignant and send them to a lab for analysis.
- Electrocautery: This involves using heat to destroy the affected tissue.
- Laser use: This final step seals and micro-contours the wound.
Although little data suggests that rhinophyma can recur following surgery, few long-term studies have been conducted.
Conclusion
A person with rhinophyma may suffer significant face flushing in the early stages. Swollen blood vessels and acne-like blemishes occur as the condition worsens.
Later on, the nasal skin thickens and the tip of the nose expands. Doctors diagnose rhinophyma at this point. It appears to be harmless at first, but it has the potential to obstruct airways and raise the risk of skin cancer.
Surgical and drug-based treatments can help, although there is limited evidence that the condition will reoccur after surgery.
Sources
- https://www.aao.org/eye-health/diseases/ocular-rosacea-facts
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7339328/
- https://www.ncbi.nlm.nih.gov/books/NBK544373/
- https://www.medicalnewstoday.com/articles/322166
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426765/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5828925/
- https://www.aad.org/public/diseases/rosacea/what-is/symptoms
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Marijuana: What are the common health benefits?
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Alcohol and migraine: What you need to understand
Many people with migraine find that specific situations trigger their symptoms. Drinking alcohol is a trigger for some people with migraine. Although any type of alcohol can provoke a migraine, people who experience recurrent migraine attacks cite red wine as the most frequent reason.
Research suggests that people with migraine may also suffer comparable symptoms after a hangover. Reducing or eliminating alcohol may reduce the frequency of migraine attacks. It may also help reduce factors that tend to co-occur with drinking, such as dehydration and sleep deprivation.
Keep reading to understand more about the connection between migraine and headache.
Is alcohol capable of causing migraines?

Migraine is a form of neurological disorder. Although hereditary factors impact the chance of developing migraine, environmental triggers can cause episodes or increase their frequency.
Several studies show that alcohol, especially red wine, may cause migraine episodes.
In a 2018 research including 2,197 adults with migraine, 25% of the participants who had discontinued or always avoided drinking did so because alcohol induced migraine symptoms. More than a third of the subjects stated that alcohol had this impact, with roughly 78% indicating red wine as the most prevalent alcohol trigger.
A 2019 research questioned patients with migraine who consumed alcohol. Of the 1,547 individuals, 783 claimed that alcohol was a trigger, while 195 were not sure. People who experienced migraine with alcohol were more likely to suffer migraine with aura and to experience more migraine days and more frequent episodes. They were also more prone to drink vodka.
A predisposition for migraine may also play a role in hangovers, especially hangovers that induce migraine-like headaches. A 2014 study of 692 students, 95 of whom experienced migraine, indicated that individuals with migraine were more likely to suffer migraine-like symptoms during a hangover. However, these people were not more prone to other hangover symptoms.
Alcohol may also create other sorts of headaches. People who get a headache after drinking should not assume that it is a migraine, especially if they have symptoms associated with other forms of headaches. For example, a stress headache may induce pain in the neck or shoulders.
Other alcohol-related headaches
Migraine creates a unique form of headache that incorporates neurological symptoms such as light sensitivity and aura. Other sorts of headaches, including severe headaches, can occur as a result of alcohol intake.
Hangover headache
A headache is a frequent hangover symptom. Alcohol can provoke symptoms in persons with a headache disease, but it can also directly induce headaches.
A 2015 study shows that the inactivity of alcohol dehydrogenase 2, an enzyme that helps break down alcohol, can contribute to hangover headaches. However, the research author also notes that no one factor causes all hangover headaches.
Tension headache
A 2016 study emphasizes that drinking may induce a tension headache, especially if a person simultaneously suffers migraine. The research revealed that 21 percent of persons with migraine indicate that alcohol is a tension headache trigger, compared with just 2 percent of people without migraine.
Cluster headache
Alcohol may provoke cluster headaches. These headaches induce very strong pain that generally predominantly affects the region behind one eye. More than half of individuals who get cluster headaches indicate that alcohol is a trigger.
Dehydration headache
Alcohol increases urine, which can contribute to dehydration. Moreover, persons who drink alcohol may not drink as much water, exacerbating the water loss. Dehydration can induce headaches. It may also provoke headaches connected to headache diseases, such as migraine.
What alcohol to consume to avoid migraine attacks
Most research point to red wine as a prevalent headache trigger, particularly in those with migraine. These individuals typically report wine, especially red wine, as a migraine trigger.
However, a 2012 research denies this relationship. This prospective research looked at migraine diaries extending up to 90 days. Wine, beer, and spirits did not enhance the risk of migraine with aura, while sparkling wine did.
People who have hangovers that induce a migraine may desire to avoid alcohol with high amounts of congeners. These are compounds that the alcohol production process creates. Some study shows that congeners have a role in hangovers, however variables like as inflammation also contribute.
Brandy, red wine, and rum have the largest quantities of congeners, whereas gin and vodka have fewer of these compounds. However, a 2019 study reported greater rates of vodka use among drinkers with recurrent migraine symptoms. The reaction to alcohol varies from person to person, and there is no drink that certainly will not trigger a migraine or other headache.
Other migraine-prevention options
Identifying and limiting or eliminating common migraine triggers such as alcohol, dehydration, and specific meals is the first step in preventing migraine. For a few weeks, a person should keep a migraine diary to detect trends in their headache patterns.
Stress-related migraines may be relieved with relaxation techniques, and migraine episodes may feel less severe when they occur.
Migraine prophylaxis drugs such as topiramate (Topamax), divalproex (Depakote), or propranolol may be useful for people who suffer frequent migraine attacks (Inderal). They can talk to a doctor about these therapy alternatives.
People who suffer from migraines while or after drinking may consider limiting or eliminating alcohol from their diet. If they find this too difficult, they may be suffering from an alcohol use disorder, which need therapy.
Conclusion
Migraine attacks can range from minor inconveniences to complete debilitation. The most severe migraine headaches can last up to three days and render you unable to work. In rare cases, a migraine attack can persist much longer.
Migraine is a complicated disorder, and migraine-like symptoms can be caused by a variety of neurological conditions. As a result, whether you’re drinking or not, it’s critical to consult a doctor if you’re experiencing migraine symptoms or chronic headaches. Migraine headaches can be treated with the appropriate combination of medicines and lifestyle changes.
People who are unable to stop drinking should consult a physician about alcohol use disorder treatment, which is a serious but treatable problem.
Sources
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8280611/
- https://headachejournal.onlinelibrary.wiley.com/doi/abs/10.1111/head.12621
- https://www.aafp.org/afp/2019/0101/p17.html
- https://www.medicalnewstoday.com/articles/alcohol-and-migraine
- https://www.proquest.com/openview/dc644a5c531eaf1bd4ca19f1ea95890a/1?pq-origsite=gscholar&cbl=136155
- https://onlinelibrary.wiley.com/doi/abs/10.1111/ene.13861
- https://academic.oup.com/alcalc/article/54/3/196/5420612?login=true
- https://americanmigrainefoundation.org/resource-library/alcohol-and-migraine/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821937/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537780/
- https://www.ncbi.nlm.nih.gov/books/NBK560787/
- https://pubmed.ncbi.nlm.nih.gov/22671771/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064176/